Summary NGR 6172 TEST 1 Questions & Answers Fall 2024 Complete Solution Guide.

NGR 6172 TEST 1 Questions & Answers Fall 2024 1. Some drugs can stimulate metabolizing enzymes and speed up their metabolism which can lower the actual effect of drugs. Which of the following drugs are known as inducing agents (select all that apply) a) Atorvastatin b) Phenytoin c) Tobacco d) St. Johns wort 2. QT prolongation can occur with some drugs and combinations of drugs. Which of the following increase the risk of QT prolongation and potential dysrhythmias (select all that apply) a) Male gender b) Female gender c) Hypokalemia d) Low magnesium 3. Sudden withdrawal of a medication that has been used chronically can create a hypersensitivity reaction. Which of the following are sensitivity responses that can occur when the medication is stopped (select all that apply) a) Abrupt cessation of metoprolol can lead to HTN b) Abrupt cessation of clonidine can lead to tachycardia c) Abrupt cessation of clonidine can lead to hypertension d) Abrupt cessation of metoprolol can lead to tachycardia 4. Match the pharmacodynamic term with the definition: a) ED50 - The dose that is required to produce a defined therapeutic response in 50% of the population b) Receptor downregulation - Desensitizing occurs when the receptors of a cell are continually exposed to an agonist (molecules that activate receptors or drugs that mimic the body’s response) the cell becomes less responsive c) Partial agonist or agonist-antagonist - An agonist that has less effect than a full agonist. d) Therapeutic index - Ratio of a drug’s LD50 (which is average lethal dose in 50% on animals tested) to its ED50 (therapeutic dose in 50% of a population) e) Idiosyncratic response - An uncommon drug response resulting from a genetic predisposition f) Bioavailability - The ability of a drug to reach the systemic circulation from its site of administration g) Tachyphylaxis - A form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time 5. Which of the following is true about NPs in Florida: a) NPs in Florida may apply for independent practice from physicians b) NPs in Florida can write a prescription for alprazolam c) Psych NPs in Florida can write prescriptions for Adderall d) NPs in Florida have physician oversite unless they are granted independent practice 6. Which of the following drug(s) have been identified as having the most adverse effects? (Choose all that apply) Notice that the selection boxes come up as squares when there are multiple answers. Partial credit is given and a deduction in given for answers that are chosen that are incorrect a) Insulin b) Heparin c) Digoxin d) Glipizide e) Lisinopril 7. Choose the true statement regarding trade name medications. a) Trade name are consistent in other countries b) Manufacturers of branded products are not allowed to reformulate their medications c) "Double medication" with brand products can be devastating d) Trade names are difficult to pronounce and market to the public 8. The FDA required the makers of Chantix to add warnings of mood changes. These adverse effects became known after the drug was released for general use. Which phase of clinical testing did this occur? a) Preclinical testing b) Phase 1 c) Phase II d) Phase IV Post marketing Surveillance 9. Which of the following is true regarding OTC drugs? (Choose all the apply) a) OTC drugs are safe b) The average home medicine cabinet contains 24 OTC preparations c) The FDA determines whether a drug is available by prescription or OTC d) Lovastatin is available OTC (Check epocrates under manufacturer tab) 10. Match the term with the description of the pharmacokinetic process: First-pass -When the liver metabolizes the drug to such an extent that only a small amount of the active drug emerges from the liver and is available in the circulation Half-life- The time for the amount of drug in the body to decrease by 50% Induction of metabolizing enzymes- When drugs that increase hepatic drugmetabolizing enzymes accelerate the metabolism of other drugs Inhibition of metabolizing enzymes- When drugs that prevent the metabolism of other drugs will increase their levels. Plateau- When drugs are administered repeatedly, their levels will gradually rise and then reach a steady state 11. Categorize the drug classes that inhibit and induce metabolizing enzymes CategoryInducers of metabolizing enzymes : • Tobacco • St. John's wort • Antiepileptic drugs CategoryInhibitors of metabolizing enzymes • Antifungals • Grapefruit juice • Clarithromycin 12. When two drugs are given at the same time that both utilize the same metabolizing enzymes, the following occurs (select all that apply) a) One drug make reach higher than expected levels if it is not metabolized b) If drugs such as statins are not metabolized, an increase in drug level may led to muscle injury c) One of the drugs that is not metabolized will not reach a therapeutic level d) The metabolizing of the drug may be increased resulting in decreased levels of the drug 13. A patient with diminished kidney function is prescribed a drug that rises to levels higher than desired. This is an example oft! a) Pharmacokinetics b) Pharmacodynamics c) Pharmacoeconomics d) Pharmacogenomics 14. Select the true statement regarding absorption of drugs. a) Liquid preparations are absorbed more rapidly than tablets b) The stomach has an extremely large surface area c) Most of the drugs are absorbed in the stomach d) Lipid soluble drugs are not able to penetrate cell membranes 15. Drugs need to exit the vascular system to reach their target and be metabolized and excreted. Choose the correct statements regarding drug movement. (Choose all that apply) a) Lipid soluble drugs are able to cross the blood brain barrier b) Ionized, highly polar, or protein bound drugs cross the placental barrier. c) Warfarin (an anticoagulant) is a drug that is highly bound to protein (99%). d) Drugs compete for protein binding sites. If one drug displaces another from albumin, the free concentration of the displaced drug will rise. 16. A patient is taking an antiepileptic drug such as phenytoin. Some seizure medications stimulate the liver to make more drugmetabolizing enzymes that speeds up the breakdown of the drug. Chose the correct statements in reference to this consideration in drug metabolism. (Choose all that apply) a) This is an example of induction of drug metabolizing enzymes. b) This is an example of inhibition of drug metabolizing enzymes. orrect! c) A drug given with an inducing agent may need to have an increased dosage. d) A drug given with an inducing agent may reach toxic levels because it is not metabolized. 17. Which of the following drugs is most likely to have a significant "first-pass" effect: a) Sublinqual nitroglycerin b) Transdermal estrogen patch c) An oral agent d) A drug given parenterally 18. Which of the following drugs has the longest half life (T 1/2 )? a) Keflex 500 mg every 6 hours b) Amoxicillin 500 mg every 8 hours c) Ciprofloxacin 500 mg every 12 hours d) Levofloxacin 750 mg daily 19. A patient stops taking their long acting once a day beta blocker (Toprol) used for blood pressure reduction. The nurse knows that when this drug is abruptly discontinued, the patient may experience tachycardia. When would the symtoms appear? a) Immediatley b) in 3 hours c) in 24 hours d) in 4-5 days (or half-lives) when the drug comes down from plateau 20. Which of the following statements are true about drugs that act as agonists or antagonists: (Choose all that apply) a) Agonists activate receptors. b) Antagonists block receptors. c) Partial agonists activate receptors to produce a lower level of intensity than full agonists. d) Pentazocine (Talwin) is a partial agonist. e) Receptor activation is always the same and never changes. 21. Which of the following statements is true regarding drug responses? a) The ED50 is the dose that is required to produce a defined response in 10 percent of the population b) A drug with a large or high therapeutic index is safe. c) A drug with a small or low therapeutic index is safe. d) The therapeutic index is calculated based on the drug's half life. 22. A patient on a lipid lowering drug (simvastatin) is prescribed erythromycin for an infection. The patient calls the office with a complaint of muscle aches. What is the most probable mechanism for this adverse reaction? Please learn how to use the interaction checker on ePocrates) a) Both drugs use the same metabolizing enzyme systems and the erythromycin inhibited the metabolism of the simvastatin leading to toxic levels. b) The simvastatin induced the metabolizing enzymes and the drug level increased. c) The kidneys could not excrete both drugs and the level of the simvastatin increased d) The combination of the two drugs cause a chelation effect. 23. Since 2015, the FDA replaced the pregnancy risk letter categories with new information that attempts to make the information more meaningful to patients and providers. Categorize the following drugs that are contraindicated or safe during pregnancy. CategoryDrugs that are contraindicated in pregnancy: • losartan • isotretinoin • warfarin • atrovastatin • lisinopril • methotrexate CategoryDrugs that are considered safe in pregnancy • heparin • levothyroxine • insulin • labetolol • albuterol • folic acid 24. Which of the following antibiotics are safe to give during pregnancy? a) amoxicillin b) doxycycline c) ciprofloxacin d) levofloxacin 25. Drug suspensions in children are calculated using mg/kg/day, however, as children reach near adult weight, using mg/kg/day would calculate to a dosage higher than that of an adult dose. Once a child reaches __________lbs, a dosage no greater than an adult dosage should be given. a) 40-50 lbs b) 50-60 lbs c) 60-80 lbs d) 88-110 lbs 26. Which of the following drugs are not recommended in children? (Select all that apply) a) doxycycline (age < 8) b) fluroquinolone antibiotics c) amoxicillin d) codeine e) aspirin 27. Dr. Beers developed a list of medications that are inappropriate in older adults. Drugs should be avoided that have a narrow therapeutic range, a long half life, and are renally excreted. Which of the following drugs are on the Beer's list? (Select all that apply) a) amiodarone b) sedating antihistamines c) sulfonylureas d) NSAIDs e) SSRIs with short half life 28. Which of the following are true about placental drug transfer: (Choose all that apply) a) Lipid soluble drugs cross the placenta easily b) The placenta and mammary tissue serve as a protective shield c) Drugs with large molecular weights such as heparin and insulin do not pass into the fetal circulation d) Factors that determine drug passage across membranes of the placenta are the same factors that determine drug passage across other membranes 29. An expectant mother exposes her fetus to an illicit drug during the fetal period (2nd or 3rd trimester). The exposure is most likely to produce a) Truncated limbs b) Cardiac defects c) Neural tube defects d) Learning deficits and behavioral abnormalities 30. Which of the following has a remote risk of harming the fetus if given to a pregnant woman (Formerly called FDA Category A-this classification is no longer used)? a) Vitamin A 8,000 units b) Isotretinoin c) Warfarin d) Levothyroxine 31. A woman of childbearing age is found to have hypertension. Which of the following treatments would be problematic a) Low sodium diet b) ACE inhibitor c) Weight loss d) Exercise 32. Select the appropriate advise for medication administration to a nursing mother: (Choose all that apply) a) The drug will be the highest for the baby when the drug peaks in the mother b) Drugs don't cross into breast milk c) Dosing immediately after breast-feeding is the best d) Avoid drugs with a long half-life 33. Pharmacokinetics in neonates and infants vary because a) Gastric emptying time in more rapid b) Albumin levels are higher than adults c) Albumin levels are lower in infant d) The skin is thick 34. A patient has an eGFR of 20. What stage of chronic renal failure does this represent a) CKD Stage 1 b) CKD Stage 2 c) CKD Stage 3 d) CKD Stage 4 35. A patient presents with proteinuria. The eGFR is >90. This represents CKD stage___________? a) 1 b) 2 c) 3 d) 4 36. Which of the following statements are true regarding kidney function in the older adult? (Choose all that apply) a) Serum creatinine is the best measure of renal function b) Women have reduced creatinine levels c) Older adults have less creatinine because they have less muscle d) African Americans have lower creatinine levels 37. Many children approach adult weight at a younger age. Prescribers know that when a child reaches_______in weight, an adult dose is given because if mg/kg/day dosing is calculated, it will be higher than an adult dose (select all that apply) a) 40-50 lbs b) 40-50 kg c) 88-110 lbs d) 120 lbs 38. Which of the following drugs are considered inappropriate for older adults (select all that apply) a) Hydroxazine b) quetiapine c) alprazolam d) Tolterodine e) Clonidine f) lisinopril 39. Match the drug class to the drug prototype • Alpha 2 agonist- clonidine • Beta 2 agonist- albuterol • Anticholinergic- ipratropium (Atrovent) • Beta adrenergic antagonist- metoprolol • Alpha 1 antagonist- prazosin 40. Anticholinergic Drugs Category Anticholinergic drugs • atropine • ipratropium (Atrovent) • tolterodine (Detrol LA) Uncategorized answers • metoprolol • clonidine 41. Anticholinergic side effects Category Anticholinergic side effects • sedation • anhidrosis • blurry vision • tachycardia • constipation • urinary retention • dry mouth Uncategorized answers • brochoconstriction • bradycardia • sweating 42. Drug classes with anticholinergic properties Category Drug classes with anticholinergic properties • Antipsychotics • First generation antihistamine • SSRI-paroxetine (Paxil) • Tricyclic antidepressants Uncategorized answers • Beta adrenergic antagonists • Alpha 2 agonists • Alpha 1 antagonists 43. Parasympathetic and Sympathetic Receptor Activation Category Parasympathetic response (vagal response) • voiding and defecation • pin point pupils (miosis) • bradycardia • bronchoconstriction Category Sympathetic response (sympathomimetic) • tachycardia • uterine relaxation • increased glucose • bronchodilation • dilated pupils (mydriasis) Uncategorized answers • paralysis 44. Another name for muscarinic agonist is: a) Sympathetic agents b) Parasympathomimetic agents c) Parasympatholytic agents d) Anticholinergic agents 45. Which of the following is a common effect of muscarinic stimulant drugs? a) Decreased peristalsis b) Decreased secretion by salivary glands c) Miosis d) Tachycardia 46. The main therapeutic effect from a muscarinic agoinst such as bethanechol is: a) Constriction of the bronchials b) Urinary retention c) Promotion of urination d) Increased heart rate 47. Select the therapeutic indications for the use of antimuscarinic drugs. (choose all that apply) a) Hypertension b) Motion sickness c) Chronic obstructive pulmonary disease (COPD) d) Overactive bladder 48. Anticholinergic side effects include all of the following: (choose all that apply) a) Bradycardia b) Blurry vision c) Urinary retention d) Dry mouth 49. Select the drugs that are classified as anticholinergics: (choose all that apply) a) Ipatropium bromide (Atrovent) b) Tolterodine (Detrol) c) Albuterol d) Drugs used to treat overactive bladder 50. Atropine overdose may cause which of the following? a) Gastrointestinal cramping b) Increased heart rate c) Increased gastric secretions d) Urinary frequency 51. A 70 year old male with benign prostatic hypertrophy (BPH) has a worsening of symptoms of urinary retention after taking an over the counter (OTC) remedy for an upper respiratory syndrome. The medication was most likely: a) Antiinflammatory b) Antihistamine c) Antitussive d) Mucolytic 52. Which of the following drug classes have anticholinergic properties (choose all that apply)? a) Tricyclic antidepressants b) Antihistamines c) Antipsychotics d) Beta blockers 53. Cholinesterase inhibitors decrease the levels of acetylcholine and are used to treat Parkinson's disease. a) True b) False 54. Which patient should not receive any atropine like drugs: a) A 50-year old with parkinsonism b) A 35-year old with peptic ulcer c) A 60-year old with glaucoma d) A 55-year old with cirrhosis 55. Which drug treats myasthenia gravis by increasing muscle strength? a) Bethanechol (Urecholine) b) Atropine c) Neostigmine (Prostigmin) d) Donepezil (Aricept) 56. Correct! Match the term in column 1 with the definition in column 2. Acetylcholine Neurotransmitter Correct! Muscarinic agonist Stimulates muscarinic receptors Correct! Anticholinergic Blocks the actions of acetylcholine Correct! Cholinesterase An enzyme that causes the breakdown of acetylcholine Correct! Atropine Example of an anticholinergic drug Correct! Nicotinic receptor Activation impacts skeletal muscle Correct! Cholinesterase inhibitors Drugs used to treat myasthenia gravis and Alzheimer's disease Other Incorrect Match Options: • Drugs that stimulate beta 2 receptors in the lung to cause bronchodilation 57. A patient with myasthenia has severe muscle weakness and trouble breathing. She is given edrophonium and her symptoms approve. The patient has: a) Myasthenic crisis b) Cholinergic crisis c) Adrenergic crisis d) Muscarinic poisoning Module 2 practice questions 58. Categorize drugs according to drug class Category Alpha 1 agonists • phenylephrine • epinephrine • pseudoephedrine Category Alpha 2 agonists (indirect acting antiadrenergic) • clonidine • guanfacine • methyldopa Uncategorized answers • metoprolol • doxazosin • atropine 59. Select the possible side effects of alpha 2 agonists such as clonidine Category Alpha 2 agonist side effects • decreased heart rate • rebound hypertension with abrupt withdrawal • fetal toxicity • decrease in blood pressure • sedation Uncategorized answers • tachycardia • insomnia 60. Match the adrenergic drugs with the indications • Epinephrine - anaphylaxis and hemostasis • Phenylephrine- nasal congestion and elevation of blood pressure • Albuterol- asthma or COPD • Dopamine- shock, renal failure 61. Which of the following statements are true in regards to using epinephrine auto-injectors (select all that apply) a) Two pack of the Epi-Pen is prescribed to patients with severe allergies b) The effect wears off in about 20 minutes c) Hospitalization is recommended because the allergic reaction may be prolonged and biphasic d) Patients with hypertension should never be given epinephrine e) Patients on beta adrenergic antagonists may be unable to respond to epinephrine 62. Match the receptor with the response when activated (use the receptor card and note where the receptors are located) Category Alpha 1 activation • Contraction of the bladder and prostatic capsule • Pupil dilation (mydriasis) • Constriction of the arterioles and veins Category Beta 1 and beta 2 activation • Increased heart rate • Uterine relaxation • Dilation of bronchi Uncategorized answers • Hypoglycemia • Bronchoconstriction • Bradycardia 63. Alpha adrenergic antagonist are mostly used for benign prostatic hypertrophy. Side effects include: (select all that apply) a) First dose hypotension b) Bradycardia c) Erectile dysfunction d) Bronchoconstriction 64. Which of the following are indications for beta adrenergic antagonists (select all that apply) a) migraine prophylaxis b) hypothyroidism c) post myocardial infarction d) asthma e) hyperthyroidism f) depression 65. Side effects of beta-adrenergic antagonists Category Side effects of beta-adrenergic antagonists • mask s/s of hypoglycemia • fatigue • bradycardia • sexual dysfunction • bronchoconstriction (with non-cardioselective BBs) Uncategorized answers • dry mouth • chest pain • Correct answer: • urinary retention 66. Categorize the beta-adrenergic antagonists Category Non selective beta blockers • propranolol • carvedilol (Coreg) • labetalol (Trandate) Category Cardio selective beta blockers • metoprolol • atenolol • nebivolol (Bystolic) Uncategorized answers • diltiazem • albuterol 67. Select the beta adrenergic agonists that have vasodilating properties also known as 3rd generation beta blockers (select all that apply) a) propranolol b) metoprolol c) labetalol (Trandate) d) carvedilol (Coreg) e) nebivolol (Bystolic) 68. Over-the-counter medications such as phenylephrine or pseudoephedrine used for cold symptoms have sympathetic properties and are contraindicated in patients diagnosed with which disease process or symptom? a) Angina b) Hypertension c) Coronary artery disease d) All of the above 69. Which drug blocks the alpha receptors in the prostatic capsule and can alleviate symptoms in men with benign prostate hypertrophy (BPH)? a) Clonidine b) Captopril c) Prazosin d) Propranolol 70. Which of the following statements are true regarding alpha adrenergic antagonists (alpha blockers)? (Choose all that apply): a) First dose hypotension can occur b) Abrupt withdrawal can cause rebound cardiac excitement c) Concurrent use with erectile dysfunction drugs can cause severe hypotension d) Floppy iris syndrome can occur making ocular surgery a challenge 71. Which drug is used to minimize tissue injury resulting from extravasation of dopamine infusion? a) Phenylephrine b) Phentolamine c) Epinephrine d) Isoproterenol 72. Nancy has a history of severe allergies to shellfish and is always certain to have her EpiPen with her. She was recently diagnosed with hypertension. Which medication choice would not be selected because it would block the beta receptors and render the epinephrine ineffective in the event of an accidental exposure to shellfish? a) Metoprolol b) Lisinopril c) Hydrochorothiazide d) hydralazine 73. The server at J. Alexander's restaurant assured Nancy that the french fries were not cooked in the same oil as the seafood. In spite of the warnings, Nancy feels a ball in her throat after ingesting the french fries and self administers the epinephrine. Immediate medical is required following epinephrine injection because: a) The effects of epinephrine begin to fade in 60-90 minutes b) Anaphylactic reactions are short in duration and do not reoccur c) Hospitalization (up to 24 hours) is recommended d) Additional treatment such as prednisone may be given to manage delayed or persistent symptoms 74. Which clinical manifestations are common side effects of albuterol? (Choose all the apply) a) Tremors b) Somnolence c) Bradycardia d) Palpitations 75. Which of the following are true statements about beta adrenergic antagonists (beta blockers)? (Choose all that apply) a) Cardio-selective beta blockers are a better choice for patients with asthma b) Abrupt withdrawal of beta blockers can lead to rebound cardiac excitation (palpitations and sometimes angina) c) Beta blockers can improve symptoms of depression d) Beta blockers can mask the symptoms of hypoglycemia which is often tachycardia 76. Drugs that stimulate the alpha 2 receptors centrally decrease the firing of sympathetic neurons to DECREASE blood pressure. These drugs are considered indirect-acting anti-adrenergic agents and include: (Choose all that apply) a) CClonidine b) Methyldopa c) Metoprolol d) Lisinopril 77. Select the beta adrenergic antagonists that block both beta and alpha receptors to lower blood pressure: (Choose all that apply) a) Metoprolol b) Propranolol c) Carvedilol d) Labetalol Table of Contents Pages Introduction to Pharmacology…………………………………………………….. ….....4 Basic Principles of Pharmacology: Pharmacokinetics…………………………………... 6 Pharmacodynamics………………………………………………………………… ……. 9 Drug Interactions……………………………………………………………………….. ..9 Adverse Drug Reactions and Medication Errors………………………………………..10 Individual Variation in Drug Responses……………………………………………. ….12 Write in The Definitions……………………………………………………………. …..13 Matching…………………………………………………………………………… …... 16 Drug Therapy Across the Lifespan - Pregnancy….. …………………………………….17 Drug Therapy in Pediatric Patients…………………………………………………. …..17 Drug Therapy in Geriatric Patients…………………………………………………. …..18 Peripheral Nervous System Drugs: Basic Principles Neuropharmacology…………………….. .20 PNS Activity…………………………………………………………………………………….. .22 Cholinergic Drugs………………………………………………………………………………...23 Muscarinic Agonists……………………………………………………………………………...23 Muscarinc Antagonists…………………………………………………………………………...24 Cholinesterase Inhibitors…………………………………………………………………………25 Neuromuscular Blocking Agents…………………………………………………………………25 Matching Cholinergic and Anticholinergic Matching……………………………………………26 UNIT 1 INTRODUCTION TO PHARMACOLOGY □ State the three (3) most important characteristics of any drug. □ Is it possible to have a selective drug? □ Define the four phases of pharmacokenetics. □ Define pharmacodynamics. □ Which member of the health care team is most likely to observe and evaluate drug responses and intervene if required? □ Name the three most important goals of pre-administration assessment. □ What factors can predispose an individual to adverse reactions from drugs? □ What measures help reduce adverse reactions of medication administration? □ What type of research is required to assess drug therapies? □ What is a "blinded" study? □ What is the purpose of having a trade name (proprietary or brand name) for a drug? □ What is one of the problems with trade names? □ What are some limitations in the testing process used to bring drugs to market? □ What is another limitation in the testing process used to bring drugs to market? □ When writing the names of drugs, generic names are not capitalized and brand name are____________? □ Which scheduled drugs can NPs prescribe in the state of Florida? □ Give an example of Schedule II drugs. (use ePocrates Manufacturer/Pricing feature) □ Give examples of Schedule III drugs. □ Give an example of a Schedule IV drugs. □ Benzodiazepines are Schedule_________ drugs? □ Which scheduled drugs can not be called into the pharmacy and require a hard copy? □ Equal active ingredients, dosage form, identical disintegration, rate of absorption, efficacy, and safety are features of what type of drugs? □A warning that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects is known as____________? □ Name a few drugs that have a Black Box Warning. □ Which class of antihypertensive drugs are recommended in African Americans (AAs)? □Activity of CYP 2D6 is (lower or higher) in Asians and may require (lower or higher) doses of drugs utilizing this metabolizing enzyme? BASIC PRINCIPLES OF PHARMACOLOGY PHARMACOKINETICS □ What are the four (4) basic pharmacokinetic processes? □ Are highly lipid-soluble drugs absorbed more (rapidly or slowly) than drugs whose lipid solubility is low? □ Why are highly lipid-soluble drugs absorbed more rapidly than low lipid soluble drugs? □ Define the term parenteral? □ At what rate should IV meds be administered? □ How long does it take an IV drug injected in the anti-cubital space to reach the brain? □ What are depot preparations? □ What kinds of compounds do not pass freely from the maternal bloodstream into the blood of the fetus? □ Benzathine penicillin G can be released at a therapeutic amount over one month from a single IM injection, what type of preparation would this be called? □ What types of compounds pass freely from the maternal blood stream into the blood of the fetus? □ What can occur when two highly protein bound drugs are given together? □ What happens when two highly protein bound drugs are given together and compete for sites on the protein? □ Give an example of a drug that is highly bound to protein. □ Drugs that are highly bound to protein may exhibit (increased or decreased) levels in the blood when the patient is found to be in a malnourished state. □ Define biotransformation (drug metabolism). □ Where does most drug metabolism (biotransformation) take place? □ If two drugs are given that both utilize the same p450 hepatic microsomal system, the drug level in the blood of the drug that is not metabolized (increases or decreases)? □ At what age does hepatic maturation occur? □ Drug metabolizing capacity in infants is (decreased or increased)? □ Some drugs are inactive and when metabolized undergo conversion to an active form. Other drugs are converted into more active forms. For example, codeine is metabolized into morphine. Some children have the ability to rapidly metabolize codeine (ultra-rapid metabolism of codeine to morphine). The out-come of this will lead to toxicity due to (increased or decreased) opioid effect? □ How is the first pass effect is circumvented? □ What is an example of a drug that if given orally would be destroyed in the “first pass” through the GI tract? □ What aspect of pharmacokinetics (absorption, distribution, excretion, & metabolism) is affected in patients with kidney disease? □ The range of plasma drug level that falls between minimum effective concentration (MEC) and the toxic concentration is called what? □ A drug with a narrow therapeutic range is (more or less) dangerous? □ The time required for the amount of drug in the body to decrease by 50% is called what? □ How many half-lives does it take for a drug to reach plateau? □ Drugs that have a long half-life need to be administered (more or less) frequently than drugs that have a short half-life. Less frequently. □ What is a loading dose? A large initial dose to hasten time to plateau □ Can drugs give cells new function? □ Agonist are molecules that (prevent or activate) receptors. □ Antagonists (activate or prevent) receptor activation? □ Drugs that mimic the body’s own regulatory molecules are called (agonists or antagonists)? □ What is a partial agonist? □ Give an example of a partial agonist. □ Desensitizing occurs when the receptors of a cell are continually exposed to an agonist (molecules that activate receptors or drugs that mimic the body’s response) the cell becomes less responsive. What is this known as? □ The dose that is required to produce a defined therapeutic response in 50% of the population is known as what? □ It is defined as the ratio of a drug’s LD50 (which is average lethal dose in 50% on animals tested) to its ED50 (therapeutic dose in 50% of a population), what is this known as? □ A drug with a high therapeutic index is considered (safe or unsafe)? DRUG INTERACTIONS □ Laxatives (reduce or increase) absorption? □ Drugs that depress peristalsis (reduce or increase) absorption? □ What are two drugs known to decrease peristalsis and cause increased drug time (and increased absorption) in the intestines? □ When an inducing drug such as phenobarbital is taken concurrently with another medication, the metabolism of the other medications is (increased or decreased)? □ Accelerated metabolism would lead to (increased or decreased) blood levels of other drugs? □ (More or less) of the other medication would be needed? □ Give examples of drugs known as inducers. □ Grapefruit juice can (inhibit or induce) the metabolism of certain drugs, thereby (raising or lowering) their blood levels? □ What are the potential consequences when calcium channel blockers are taken with grapefruit juice? □ How long would the impact of grapefruit juice be expected to last? □ How would you administer a drug “on an empty stomach”? ADVERSE DRUG REACTIONS AND MEDICATION ERRORS □ Patients over what age account for over 50% of all adverse drug reactions (ADR’s). □ When do side effects usually occur? □ Can an allergic reaction occur without prior sensitization to the immune system? □ Define idiosyncratic effect from a drug. □ Succinylcholine, a drug used to promote flaccid paralysis of skeletal muscle, can cause paralysis. In most patients, the paralysis is brief. However, in some patients the genes that code for succinylcholine-metabolizing enzymes are abnormal, producing enzymes that inactivate the drug slowly leading to prolonged paralysis. What type of effect is this? □ What is a life threatening response characterized by bronchospasm, laryngeal edema, and drop in BP? □ Why is abrupt discontinuation of a medication discouraged? □ What is the potential consequence of a medication that prolongs the QT interval? □ Why are women at more at risk for QT interval prolongation? □ What is the most common cause of acute liver failure and hepatotoxicity? □ Define teratogenic. □ Define iatrogenic. □ What are the three most common causes of fatal medication errors? □ What is REMS? □ What are the four drugs/classes that cause the greatest number of adverse reactions? □ What setting do most of the drug errors occur? □ Which is correct? □ MS (morphine sulfate), MSO4 and MSGO4, > (greater than), < (less than), abbreviations for drug names, apothecary units, @, Cc, ug....all have one thing in common. What is it? INDIVIDUAL VARIATION IN DRUG RESPONSES □ Why are older adults more sensitive to drugs? □ The ability of a drug to reach the systemic circulation from its site of administration is known as what? □ The component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug is known as what? □ A form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time is known as what? □ Give an example of a drug that exhibits tachyphylaxis. □ Define tolerance. □ A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency that takes aspirin or a sulfonamide is at risk for what disorder? □ During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require (increased or decreased) drug amount? □ Which class of antihypertensive drugs are recommended in African Americans? □ Activity of CYP 2D6 is (lower or higher) in Asians and may require (lower or higher) doses of drugs utilizing this metabolizing enzyme? □ Which herbal remedy is an inducer and can decrease the levels of warfarin, cyclosporine, oral contraceptives and antiretroviral medications? □ Name a drug that is an inducer. □ A disease or condition produced by a doctor or other health care provider or drugs is known as what? □ Do pharmacokinetics change throughout the lifespan? □ Do pharmacodynamics change throughout the lifespan? □ Give examples of drugs that have genetic testing recommended ACTIVITIES PHARMACODYNAMICS Terms Write in the Definition Agonist Antagonist Desensitization Downregulation ED50 Efficacy Hypersensitivity Intrinsic activity Lethal dose Partial agonist Potency Receptors PHARMACOKINETICS Term Write in the Definition Absorption Affinity Bioavailability Bioequivalent Biotransformation Blood-brain barrier Chemical equivalence Chronic kidney disease(CKD) Contraindication Creatinine Creatinine clearance Depo preparation Distribution Enteral Enteric Estimated GFR (eGFR) Excretion Extended release (ER) First- pass effect Formulation Generic Ghost capsules Half-life (T ½) Induction Inhaled formulations Inhibition Lipophilic Loading dose Metabolite Minimum effective concentration (MEC) P450 enzyme system Parenteral Per os (PO) Peak level Pharmacokinetics Pharmacogenetics P glycoprotein Placental drug transfer Plateau Prodrug Protein binding Reconstitution Renal dosing Scored Substrate Suppository Sustained-release Synergistic Therapeutic range Topically Transdermal Trough level Matching (Choose from the list at the end) Rapid hepatic elimination of a drug without achieving its therapeutic effect __________ Drugs that act on the liver to increase rates of drug metabolism __________ The ability of a drug to reach the systemic circulation __________ Drugs that decrease the metabolism of other drugs by inhibiting hepatic enzymes __________ Drugs that mimic the body’s own regulatory molecules __________ What the body does to the drug pharmacokinetics What the drug does to the body Pharmacodynamics The time for the amount of drug in the body to decrease by 50% __________ The dose required to produce a therapeutic effect in half of the population ED-50 Genetic differences at the drug receptor making drug efficacy and toxicity vary __________ Choose from the Following Terms DRUG THERAPY ACROSS THE LIFESPAN PREGNANCY □ Recently, the FDA made a change on how it classifies drug risk in pregnancy. What is the change? □ During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require (increase or decrease) in drug dosages? □ What class of blood pressure medication should not be taken during pregnancy? □ Name a drug class that was formerly Category X that is used to treat hyperlipidemia. □ Which antibiotics should not be taken during pregnancy? □ Give an example of 2 conditions that would require treatment regardless of the risk of the medications. □ When is the best time to take a medication if breast feeding? DRUG THERAPY IN PEDIATRIC PATIENTS □ Drugs with a (long or short) half-life should be avoided when breastfeeding. □ A neonate is defined as (less or more) than 4 weeks of age? □ Protein or albumin is (higher or lower) in an infant which might lead to (increased or decreased) levels of a drug bound to protein? □ Hepatic metabolism and renal excretion in infants is (high or low)? □ Why are neonates especially sensitive to drugs that affect the CNS? □ Children’s dosages are calculated as mg/kg/day. Sometimes the mg/kg/day are more than the adult dose. When would a child be given an adult dose rather than the mg/kg/day? □ Once a pediatric patient weighs_____________, it is time to switch to an adult dose. □ Why might a growing child require a higher dose than an adult? DRUG THERAPY IN GERIATRIC PATIENTS □ Older adults have more body fat and decreased total body water. Because of this plasma concentrations of lipid-soluble drugs may be (low or high) and concentrations of water-soluble drugs may be (low or high). □ Serum albumin may be lower in older individuals. This would cause some drug levels to (increase or decrease)? □ The rate of drug absorption in the elderly is (slow or accelerated)? □ Drugs last longer in the elderly due to (decreased or increased) liver function? □ What is the most important cause of drug reactions in the elderly? □ What is creatinine clearance? □ Creatinine levels do not reflect kidney function in the elderly because the source of creatinine is lean muscle which declines in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced. True or false? □ Why is creatinine clearance important in the elderly more so than serum creatinine? □ A list of drugs that have increased adverse events in the elderly and are not considered appropriate for use in the elderly is known as the _____________? □ For eGFR in women, multiply equation by 0.85. Normal GFR is greater than 90 mL/min in women and greater that 100 mL/min in men. The National Kidney Foundation has established the following stages of chronic kidney disease (CKD): Stage V is a GFR of_______? □ Why are drugs with a short half life preferred in older individuals? □ Why do 75% of older adults intentionally stop taking their medications? □ When a drug activates receptors directly, it is called an (agonist or antagonist)? □ When a drug mimics the effects of a natural transmitter it (increases or decreases) receptor activation? □A drug that promotes transmitter release (increases or decreases) receptor activation? □ Stimulation of the (sympathetic or parasympathetic) system has the following effects on these organs: Heart-slows; Stomach-salivation, increased gastric secretions; Bowel and bladderincreased intestinal tone and motility, defecation; Eye- constriction; Lung- constriction of bronchi; Sweat glands- generalized sweating; Blood vessels- vasodilation Parasympathetic system □ What is the purpose of the baroreceptor response? □ Stimulation of the (sympathetic or parasympathetic) system has the following effects: Heart rate- increases; Blood pressure- increases; Skin-shunting of blood away from the skin and viscera and into skeletal muscles; □ Cholinergic receptors react to responses of which neurotransmitter? □ (Adrenergic or cholinergic) receptors mediate responses to epinephrine and norepinephrine? □ Nicotinic n Nicotinicm and muscarinic are three subtypes of which types receptors? □ State the subtypes of adrenergic receptors. □Activation of (adrenergic or cholinergic) receptors would have the following effect on: Glandular secretion- increase; Bronchi- constriction; GI tract- salivation, increased gastric secretions, increased intestinal tone and motility, and defecation; Heart- decrease heart rate; Eye- miosis (constriction)? □ State another name for muscarinc agonists? □ Which adrenergic receptors are located in the eye, arterioles, viscera and mucous membranes, veins, male sex organs, & prostate capsule? □Activation of ___________________receptors have the following effects: Blood vessels constriction, sexual apparatus ejaculation, and the smooth muscle contraction of the bladder neck and prostatic capsule. □A drug that blocks alpha 1 receptors (alpha antagonist) would be used to (increase or decrease) blood pressure? □A consequence of using an alpha antagonist might have what effect on sexual function? □ Where are the beta1 receptors located? □ What is the response to activation of beta1 receptors in the heart and kidney? □ Where are beta2 receptors located? □Activation of ______________receptors has the following effects: Arterioles (heart, lung and skeletal muscle)- dilation; Bronchi- dilation Uterus- relaxation; Liver- glycogenolysis; Skeletal muscle- enhanced contraction, glycogenolysis Beta2 □ Blocking beta2 receptors by giving a beta antagonist (beta blocker) would cause (dilation or constriction) of bronchi? □Activation of dopamine receptors in the kidney (increases or decreases) renal blood flow? Activity: The following chart MUST be memorized. Fill in the blanks □ What is the effect of activation of muscarinic receptors in the eyes? □ Bethanechol (Urecholine) activates muscarinic receptors and leads to (urination or urinary retention)? □ What are the signs of muscarinic poisoning? Profuse salivaton, tearing, visual disturbances, bronchospasm, diarrhea, bradycardia, and □ What is the treatment of muscarinic poisoning? □ State other names for muscarinic antagonists. □ Atropine (increases or decreases) heart rate? □ Blurry vision, photophobia, increased intraocular pressure, urinary retention, dry mouth, constipation, anyhidrosis, and tachycardia and sedation (BUDCATS) are adverse effects of ________________? □ What are the s/s of antimuscarinic poisioning? □ Which drug class is used to treat an overdose of anticholinergic or antimuscarinic agents? □ Drugs to treat urge incontinence are (anticholinergics or muscarinic agonists)? □ According to the Beers Criteria, which anticholinergic drugs are potentially inappropriate for use in geriatric patients? □ Give and example of an anticholinergic drug used to treat respiratory problems. □ Name additional drug classes that have anticoholinergic effects? □ Cholinesterase inhibitors, used to treat myasthenia gravis and Alzheimer's disease (increase or decrease) levels of acetylcholine? □ Preventing degradation of ACh ( increases or decreases) muscle strength? Increases □ What are the adverse effects of having excess amounts of Ach which occurs when the enzyme is blocked that breaks it down (MOA of cholinesterase inhibitors)? □ What drug should be available to treat a patient with a confirmed cholinergic crisis? □ What are some of the uses for cholinesterase inhibitors? □ What are the uses for neuromuscular blocking agents? □ Some patients with genetic alterations have persistent paralysis after the use of succinylcholine (a neuromuscular blocking agent). The inability to degrade succinylcholine is an_________________reaction. Idiosyncratic reaction. □ An adverse reaction triggered by succinylcholine as well as all inhaled anesthetics in which temperature elevates due to uncontrolled metabolic activity in muscle is called______________________? □ What is the name of the drug used to treat malignant hyperthermia?